Transition from pediatric to adult care in type 1 diabetes mellitus: a longitudinal analysis of age at transfer and gap in care

Abstract

IntroductionAdolescents and young adults (AYAs) with type 1 diabetes (T1D) are at risk of suboptimal glycemic control and high acute care utilization. Little is known about the optimal age to transfer people with T1D to adult care, or time gap between completing pediatric care and beginning adult endocrinology care.Research design and methodsThis retrospective, longitudinal study examined the transition of AYAs with T1D who received endocrinology care within Duke University Health System. We used linear multivariable or Poisson regression modeling to assess the association of (1) sociodemographic and clinical factors associated with gap in care and age at transfer among AYAs and (2) the impact of gap in care and age at transfer on subsequent glycemic control and acute care utilization.ResultsThere were 214 subjects included in the analysis (54.2% female, 72.8% white). The median time to transition and age at transition were 8.0 months and 21.5 years old, respectively. The median gap in care was extended by a factor of 3.39 (95% CI=1.25 to 9.22, p=0.02) for those who did not see a mental health provider pre-transfer. Individuals who did not see a diabetes educator in pediatrics had an increase in mean age at transition of 2.62 years (95% CI=0.93 to 4.32, p<0.01). The post-transfer emergency department visit rate was increased for every month increase in gap in care by a relative factor of 1.07 (95% CI=1.03 to 1.11, p<0.01). For every year increase in age at transition, post-transfer hospitalization rate was associated with a reduction of a relative factor of 0.62 (95% CI=0.45 to 0.85, p<0.01) and emergency department visit rate by 0.58 (95% CI=0.45 to 0.76, p<0.01).ConclusionsMost AYAs with T1D have a prolonged gap in care. When designing interventions to improve health outcomes for AYAs transitioning from pediatric to adult-based care, we should aim to minimize gaps in care.

Evaluation of Psychological Resources of Young Adults With Type 1 Diabetes Mellitus During the Transition From Pediatric to Adult Diabetes Clinics: Multicenter Cross-sectional Study

“…2. Perceived Stress Scale (PSS-10): a 10-item questionnaire originally developed by Cohen et al [13] that is widely used to assess stress levels in young people and adults aged 12 years and older; it evaluates the degree to which an individual has perceived life as unpredictable, uncontrollable, and overloading over the previous month. 3. Satisfaction with Life Scale (SWLS) [14]: a measure of global life satisfaction; scores on the SWLS correlate moderately to highly with other measures of subjective well-being and correlate predictably with specific personality characteristics.…”

“…These changes also concern diabetes; patients have to confront with the need to become responsible for various decisions and duties that so far were more caregiver based. It is necessary to undertake the responsibility for everyday management of diabetes-both emotional and clinical, which may be overwhelming, especially for young people whose parents were either overprotective or not engaged, which is a common issue in families with a child with chronic disease [2][3][4]. The results of the SEARCH for Diabetes in Youth Study [5] indicated a 2.5-fold increase in the risk of deterioration of metabolic control in a young adult cohort with T1DM leaving pediatric care compared to those under the care of pediatric clinics.…”

ISPAD Clinical Practice Consensus Guidelines 2022: Management of the child, adolescent, and young adult with diabetes in limited resource settings

“…Some clinics in LRS transition at age 12 years while most transition between ages 15 and 21 years. There are numerous reports from around the world in high, middle and low resource settings that document the deterioration of glycemic control associated with increased acute and chronic morbidities in the PwD in the adolescent and young adult years, 86 and efforts to address these problems continue. Being aware of these difficulties, having honest discussions with the PwD and family and having joint programs for a few years between pediatricians and adult physicians has been helpful in raising awareness and addressing these issues.…”